1. health and fitness
2. disease
3. cancer

1st German Arab Medical Conference
October 24th – 26th 2014
in Berlin
progr a m
Sh a ping F u t ur e He a lt h
Cancer Diagnostics and Treatment
multidimensional – interdisciplinar y – interprofessional
Charité Comprehensive Cancer Center
Suppor ted by:
European
Centre of Expertise
for the Healthcare Industry
Deutsch-Arabische Krebskonferenz
www.dakk-berlin.de
Die Anerkennung als ärztliche Fortbildungsmaßnahme und Bewertung mit
Fortbildungspunkten durch die Ärztekammer Berlin (ÄKB) ist beantragt.
Fortbildungspunkte können nach der erforderlichen Eintragung in der Teilnahmeliste
zum 1. Deutsch-Arabischen Krebskongress beantragt werden.
Berlin Medical Association (ÄKB) is requested to certify this conference as part of
continuous medical education with CME credit points. You can apply for CME credit
points after registration in the list of participants of 1st German Arab Medical
Conference in Berlin 2014.
2
1st German-Arab Medical Conference
in Berlin
Shaping Future Health
Cancer Diagnostics and Treatment
Deutsch-Arabische Krebskonferenz
multidimensional – interdisciplinary – interprofessional
Principle Scientific Partner:
Charité University Medicine Berlin
Organization Partners:
Berlin Partner for Business and Technology
Chamber of Commerce and Industry of Berlin (IHK)
Organizer: German Arab Friendship Association (DAFG)
Organizational committee:
El Hana GmbH
Date:
October 24th – 26th 2014
Venue:
Chamber of Commerce and Industry of Berlin (IHK)
Ludwig-Erhard-Haus
Fasanenstraße 85, 10623 Berlin
Charité Comprehensive Cancer Center
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1st German-Arab Medical Conference
in Berlin
„Shaping future health“
Conference on Cancer Diagnostics and Treatment
Berlin-2014
The 1st German Arab Medical Conference in Berlin „Shaping Future
Health“ will take place from October 24th - 26th 2014. From 2014 Berlin
is going to witness this international medical conference every year.
The 1st German Arab Medical Conference in 2014 will focus on „Cancer
Diagnostics and Treatment“.
The conference is a scientific medical congress for German and Arab physicians from the Arab world, Germany and worldwide. Scientific contributions reflect cutting edge research in diagnostics and treatment.
In addition to panels, workshops and poster sessions there will also be
a session „Meet the Professor“, offering young physicians from the Arab
world the chance to meet Berlin professors and medical specialists who
are ready to accompany and guide their postgraduate training.
„Berlin Partner for Business and Technology“, Berlin’s official marketing
agency, is the principal partner in the conference organization. The scientific Organization committee includes Prof. Dr. Sehouli, Director of Clinic
of Gynecology, Charité University Medicine, Berlin ; Prof. Dr. Ulrich Keilholz, acting Director of Charité Comprehensive Cancer Center and Prof.
Dr. Abdulgabar Salama, acting Director of Charité Institute for Transfusion
Medicine.
Arab health ministries and medical institutes of renowned universities are
the conference’s principal partners from the Arab world. The Chamber
of Commerce and Industry of Berlin (IHK) is partner of the conference representing the commercial health sector.
The 1st German Arab Medical Conference will be celebrated under the
auspices of His Excellency Prof. Dr. med. Shobokshi, ambassador of the
Kingdom of Saudi Arabia in Berlin. The Secretary of State in the Ministry of Economy, Technology and Research of Berlin, Henner Bunde and
Dr. Layla Najim, Arab League Director of Health and Humanitarian Aid, will
welcome the conference participants at the opening ceremony.
Furthermore, „Shaping Future Health“ is the place to network, exchange
4
information and initiate cooperation among German and Arab physicians
practicing in Berlin and their colleagues from the Arab world.
For the opening ceremony and gala dinner, guests of honor are expected,
the Arab diplomatic corps, delegates of Arab and German health policy
and chamber of German physicians, as well as executives of Arab and German companies active in health business.
Scientific Prospect
With this unique congress we want to establish a sustainable platform for
the induction and intensification of scientific and clinical projects between
Germany and the Arab countries.
Based on the existing collaboration in patient care between the Charité
and a number of prominent Arab medical institutions, we want to expand
these activities.
At the German Arab Medical Conference in Berlin we will discuss all important issues concerning frequent diseases with emphasis on differences
between German and Arab patients and the relevance of these differences for disease management. The 1st German Arab Medical Conference
in Berlin 2014 will focus on cancer.
Moreover, this congress will be held immediately after the annual Berlin
Health Week, thus enabling conference visitors to get an overall view of
Berlin as a health city with world reputation.
The conference discussions will cover biomedical research, surgical and
medical treatment options and patient counseling considering also the
differences in socio-cultural background and health care systems. This
multi-dimensional, interdisciplinary and interprofessional approach is
absolutely necessary to significantly improve the outcome of our patients.
The objective of this conference should be medical education and transfer
of knowledge and the initiation of mutual comparative research projects.
The envisioned comparative research projects will be highly relevant in
order to help closing a huge science gap: There is broad knowledge concerning differences between pathogenesis, molecular disease factors and
host contribution to disease between Caucasian and Asian populations,
but very little research has been carried out on Arab and African populations. Such research projects are expected to be crucial to fulfill our
expectations regarding personalized medicine.
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We invite all researchers and physicians as well as providers
from health care systems from all Arab countries as well as from
Germany who are interested in networking and inactivities to
optimize current standards.
Young physicians and researchers from all over the world are
also invited to present their projects during our poster sessions.
The best three abstracts will be awarded with a poster price.
Partners
Charité University Medicine
Berlin Partner for Business and Technology
Chamber of Commerce and Industry of Berlin (IHK)
Berlin Partner for Business and Technology invites her partners, media
and journalists from the Arab world and Germany to participate and to
cover the congress
Participants
There are at least 500 participants expected from the Arab world and
Germany.
Arab physicians from Germany, German physicians, Arab physicians from
Arab countries and worldwide are not the only participants expected. The
1st German Arab Medical Conference will also be a forum for representatives of German hospitals with international partners and patients, as well
as Arab and German companies involved in the health care sector.
•
Arab health politicians
•
German health politicians
•
Ambassadors
•
Health attachés of Arab embassies
•
Medical specialists
•
Physicians
•
Directors of clinics and hospitals
•
Head physicians
•
Administrative directors
•
Media representatives
•
Experts in Arab German medical cooperation
•
Representatives of Arab companies in the health sector
•
Representatives of German companies in the health sector
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Guests of Honor
For the opening ceremony and gala dinner, guests of honor are expected,
the Arab diplomatic corps, delegates of Arab and German health policy
and chamber of German physicians, as well as executives of Arab and German companies active in health business.
Auspices
The 1st German Arab Medical Conference will be celebrated under the
auspices of HE the ambassador of Saudi Arabia to Germany, Prof. Dr. med.
Shobokshi. The Secretary of State in the Ministry of Economy, Technology
and Research of Berlin, Henner Bunde and Dr. Layla Najim, Arab League
Director of Health and Humanitarian Aid will honor the conference with a
welcoming address.
Scientific Committee of the
1st German Arab Medical Conference
in Berlin 2014
8
•
Prof. Dr. med. Abdulgabar Salama
Acting director of Institute for Transfusion Medicine, Charité University Medicine
•
Prof. Dr. Keilholz
Acting director of Charité Comprehensive Cancer Center; vice director, medical department hematology and oncology, Charité University Medicine
•
Prof. Dr. med. Sehouli
Director of Gynecological Department, Charité University Medicine
Conference Program
On Friday, October 24, 2014, the official opening plenary session will take
place 9:00 – 11:00, followed by a full program of sessions and workshops,
beginning at 11:00 a.m. at IHK Berlin, Ludwig-Erhard-Haus, Fasanenstraße 85, 10623 Berlin, to be continued Saturday morning, October 25.
Saturday afternoon plenary and reporting sessions will follow. The meeting will conclude with a reception at the Saudi Arabian embassy.
Welcoming addresses
Message from Deputy Chief Executive of the Berlin Chamber of
Industry and Commerce, Christian Wiesenhütter
Message from the Secretary of State in the Ministry of Economy,
Technology and Research of Berlin, Henner Bunde
Message from the Doyen of Arab Ambassadors to Germany,
Prof. Dr. med. Shobokshi
Message from Dr. Layla Najim, Arab League Director of Health
and Humanitarian Aid
Message from German Arab Friendship Association,
President Dr. Otto Wiesheu
Message from the Permanent Secretary, German Ministry of
Health, Ortwin Schulte
Message from Professor Dr. Jalid Sehouli, Director of the Department of Gynecology. On behalf of the Scientific Committee
Message from Professor Dr. Ulrich Keilholz, Acting director of
Charité Comprehensive Cancer Center. On behalf of the
Scientific Committee
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Sessions
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•
•
•
•
•
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Molecular disease characteristics – is there Arab European diversity?
Management of breast cancer
Management of colorectal cancer
Management of head and neck cancer
Management of lung cancer
Management of ovarian cancer and other gynecological malignancies
Counseling aspects with emphasis on cultural diversity
Discussion Session
Poster Sessions
Ceremonies and Social Program
Official opening ceremony
Friday, October 24, 9:30 am
The official opening ceremony takes place at IHK Berlin, Ludwig-ErhardHaus, Fasanenstraße 85, 10623 Berlin, with welcome addresses of Arab
and German high ranking representatives.
Gala Dinner
Saturday, October 25, 7:30 pm
Saturday evening at 7:30 pm we celebrate the opening of the conference
with a gala reception including musical performance, gala dinner, welcoming addresses and award presentations at the Hotel Maritim Pro Arte.
Berlin Dialogue
Sunday, October 26, 10:00 am
Reception and résumé of the 1st German Arab Medical Conference in
Berlin at the embassy of the Kingdom of Saudi Arabia.
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Venues
Organizer:
IHK Berlin, Ludwig-Erhard-Haus,
Fasanenstraße 85,
10623 Berlin
DAFG e.V. Deutsch-Arabische
Freundschaftsgesellschaft e.V.
Friedrichstr. 185, Kontorhaus Mitte
10117 Berlin
Phone: +49 (0)30. 20 64 88 88
Fax: +49 (0)30. 20 64 88 89
Web: www.dafg.eu
Mail: [email protected]
Hotel Maritim Pro Arte
Friedrichstraße 151,
10117 Berlin
Embassy of the Kingdom of Saudi Arabia
Tiergartenstr. 33-34,
10785 Berlin
Information, Organization:
El Hana GmbH
Unter den Linden 77
Im Hotel Adlon Kempinski, 10117 Berlin
Phone: +49 (0)30. 20 64 58 55
Mail: [email protected]
11
1st German-Arab Medical Conference
in Berlin
Sessions and workshops
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Session 1: Plenary Session Friday 24.10.2014 11:00 –13:00
Molecular disease characteristics –
is there Arab European diversity?
Chair: Prof. Dr. Ulrich Keilholz / Prof. Dr. Hamdi Abd El Azim
1. Colon cancer
11:00 – 11:15
11:15 – 11:30
Prof. Dr. Christine Sers
2. Breast cancer
11:30 – 11:45
11:45 – 12:00
Dr. Barbara Ingold Heppner
3. Head and neck cancer
12:00 – 12:15
12:15 – 12:30
PD Dr. Ingeborg Tinhofer-Keilholz
4. Lung cancer 12: 30 – 12:45
PD Dr. Frederick Klauschen
5. Ovarian cancer 12:45 – 13:00
Dr. Ioana Elena Braicu
Prof. Nadia Mokhtar
Prof. Nadia Mokhtar
Prof. Dr. Alaa El Abouelnasr
Session 2: Friday 24.10.2014 14:00 – 16:00
Management of breast cancer
Chair: Prof. Dr. Jens-Uwe Blohmer, Prof. Dr. Mostafa Abouelnasr
1. Role of surgery for primary and
local advanced breast cancer
14:00 – 14:15
14:15 – 14:30
14:30 – 14:45
Dr. Farkher Ismaeel
Dr. Omar Youssef
Prof. Hatem Aboul Kassem
2. Role of radiotherapy in curative
treatment 14:45 – 15:00
PD Dr. Ulrike Höller
3. Neoadjuvant and systemic therapy
of breast cancer: Option for all
patients? 15:00 – 15:15
Prof Dr. Jens-Uwe Blohmer
4. Familial breast and ovarian cancer
15:15 – 15:30
Dr. Dorothee Speiser
Dr. Elke Rodekamp
5. Treatment of breast cancer during
pregnancy 15:30 – 15:45
Dr. Wael Darwish
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Session 3: Friday 24.10.2014 14:00 – 16:00
Management of colorectal cancer
Chair: Prof. Dr. Martin E. Kreis, Prof. Dr. Reinhold Schäfer,
Prof. Dr. Alaa El Haddad
1. Role of surgery for primary and
metastatic disease 14:00 – 14:15
14:15 – 14:30
Prof. Dr. Johannes Pratschke
Prof. Wael Gawad
2. Role of radiotherapy in rectal cancer
14:30 – 14:45
PD Dr. Harun Badakhshi
3. Medical treatment of primary and
metastatic colorectal cancer
14:45 – 15:00
15:00 – 15:15
Prof. Dr. Hanno Riess
4. New developments of targeted
therapies 15:15 – 15:30
15:30 – 15:45
Susen Burock
Session 4: Prof. Hatem Aboul Kassem
Dr. Wael Darwish
Friday 24.10.2014 16:30 – 18:00
Management of head and neck cancer
Chair: Prof. Dr. Ulrich Keilholz, Prof. Dr. Volker Budach,
Prof. Dr. Abdulraheem Gari
1. Pathophysiology of head and
neck cancer 16:30 – 16:45
PD Dr. Ingeborg Tinhofer-Keilholz
2. Modern radiotherapy for
locally advanced head and
neck cancer 16:45 – 17:00
17:00 – 17:15
Dr. Carmen Stromberger
Prof. Nadia Mokhtar
3. 3. Role of medical treatment
for management of advanced
head and neck cancer and
new developments of targeted
therapies 17:15 – 17:30
Prof. Dr. Ulrich Keilholz
17:30 – 17:45
Dr. Wael Darwish
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Session 5: Friday 24.10.2014 16:30 – 18:00
Management of lung cancer
Chair: Prof. Dr. Norbert Suttorp, Prof. Dr. Hossam Kamel
1. Surgery vs. radiotherapy of primary
disease
16:30 – 16:45
16:45 – 17:00
17:00 – 17:15
PD Dr. Jens-Carsten Rückert
PD Dr. Harun Badakhshi
Prof. Wael Abdel Gawad
2. Role of medical treatment for
management of advanced lung
cancer and new developments of
targeted therapies 17:15 – 17:30
Caroline Anna Peuker
Session 6: Saturday 25.10.2014 9:30 – 11:30
Management of ovarian cancer and other
gynecological malignancies
Chair: Prof. Dr. Jalid Sehouli, Prof. Dr. Omar Sharif
1. Diagnostics 9:30 – 9:45
Dr. Ioana Braicu
2. Pathology 9:45 – 10:00
Dr. Wolfgang Schmitt
3. New Aspects of Surgery in Ovarian
Cancer 10:00 – 10:15
Dr. M. Z. Muallem
4. Current aspects of surgical and
medical therapies in relapsed ovarian
cancer 10:15 – 10:30
Prof. Dr. Jalid Sehouli
5. Current aspects of surgery in cervical
and endometrial cancer 10:30 – 10:45
Dr. Jihad Dowaji
6. The application of Jasargil Clip in radical
vaginal Trachelectomy make it easier
10:45 – 11:00
Dr. Shadi Younes
7. Role of robotic surgery in
gynaecological cancers 11:00 – 11:15
PD Dr. Mandy Mangler
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Session 7: Saturday 25.10.2014 12:30 – 14:00
Counseling aspects with emphasis on cultural
diversity
Chair: PD Dr. Jonas Felix Busch / PD Dr. Dirk Böhmer
1. Informing a patient on
therapeutic options, shared
decision making
12:30 – 12:45
PD Dr. Jonas Felix Busch
12:45 – 13:00
PD Dr. Dirk Böhmer
2. Patient expectations from
doctors and other health
care professionals
13:00 – 13:15
Prof. Dr. Jalid Sehouli
3. Counseling in palliative
care, diversity in core values
and expectations
13:15 – 13:30
PD Dr. Anne Letsch
4. Perspectives of Traditional
European, Arabian
and Asian Medicine in
Integrative Oncology
13:30 – 13:45
Prof. Dr. Andreas Michalsen
5. Pain management in cancer
and non-cancer pain“
13:45 – 14:00
Prof. Dr. Michael Schäfer
Discussion Session
Saturday 25.10.2014 14:30 – 15:30
Dr. Layla Nijem (Arab League), Prof. Dr. Ulrich Keilholz
Prof. Dr. Jalid Sehouli, Prof. Dr. Reinhold Schäfer, Prof. Wael Gawad
1. How to create an efficient German Arab research consortium
2. Meeting summary and future perspectives (½ hr)
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Workshop: Saturday 25.10.2014 16:00 – 17:30
Allogeneic stem cell transplantation
Chair: Prof. Dr. Renate Arnold
1. Indications and Results
Prof. Dr. Renate Arnold / Dr. Mohammad Ahmed A Shinawi
2. Doner Selection
Dr. Constanze Schönemann
3. Transplant
Dr. Olga Abach
4. Supportive Care
Prof. Dr. Renate Arnold / Dr. Mohammad Ahmed A Shinawi
Poster Session
Saturday 25.10.2014 16:00
• Prof. Dr. U. Keilholz
• Prof. Dr. J. Sehouli
• Prof. Dr. Mostafa Abouelnasr
• Prof. Dr. Abdulraheem Gari
Sunday 26.10.2014 10:00 – 12:00
In celebration of Berlin Dialogue:
Embassy of the Kingdom of Saudi Arabia
Future prospects of German Arab medical cooperation
Prof. Dr. med. Shobokshi, Mrs. Layla Nijem (Arab League),
Prof. Dr. Ulrich Keilholz, Prof. Dr. Jalid Sehouli
Please notice:
From Sunday, October, 26 2014 time changes to wintertime in Germany.
During the night it changes from 03:00 o’clock to 02:00 o’clock.
Subject to alterations | Änderungen vorbehalten!
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1st German-Arab Medical Conference
in Berlin
Abstr acts
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Antero-Posterior Perineal Approach-APPA - for Sphincter
Preservation in Ultra Low Rectal Cancer.
Oncologic and Functional Outcome.
Wael M.S.Gawad, Osman Mansour, Mohammed Lotief, Mona Sakr
National Cancer Institute,Cairo University
Abstract
Background: The perineal dissection through an antero-posterior perineal entry has been introduced to minimize the oncological drawbacks
encountered with ultra-low rectal tumours resection (2-5 cm) from the
anal verge as Circumferential Resection Margin (CRM) involvement, inadvertent introperative bowel perforation with subsequent increase in local
recurrence rate and low overall survival. This approach confers better
access to low seated rectal tumours enabling sphincter saving and bowel
continuity with better life quality.
Methods: Between 2008 and 2012, 35 consecutive patients with low rectal cancer tumours (3-5 cms) from anal verge,underwent ultra low rectal
anterior resection with concomitant anteroposterior perineal entry compared to 45 patients with conventional low anterior resection.All patients
received neoadjuvant cemoradiation with R0 resection. Patients’data
was prospectively collected from our colorectal database. Rates of CRM
involvement, bowel, perforation and wound infection were compared.
Continence was subjectively evaluated according to Kirwan scale. The
sphincter preservation and Colo-Anal Anastomosis (CAA) in the anterioposterior approach was achieved through either hand sewing in 10
patients or double stapling technique in 25 patients with protective ileostomy in 15 patients.
Results: The rates of CRM involvement, bowel perforation and wound
infection in such approach versus conventional resection were 5% vs
10% (p = 0.04), 5% vs 21.1% (p = 0.521) and 11% vs 31% (p = 0.518) respectively. The mean distal clear margin was 1.5± 0.5 cms (range 0.5-1.7) versus
1±0.3 cms (0.3 - 1.2). Mean Operative time was lower with the perineal
entry than with conventional surgery (220.3 & 300 minutes) respectively
(p = 0.04). The post operative stay was 10±3 days (range 5-13) compared to
12±5 (range 6-15) in the conventional group. Continence to stool and flatus was achieved in 48 patients (88%) Kirwan scale I, while 7 patients (12%)
had control to stools only.
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Conclusion: This technique facilitates addressing ultra-low rectal tumours,
with increased chances for sphincter preservation and bowel continuity
concomitant with superior oncologic outcome compared to the conventional techniques suggesting its significance as a valid approach for low
seated rectal tumours.
Breast conservation of Tx breast cancer:
is it feasible?
By Hatem Aboul Kassem1, Emad El-Gemeie2
2
1
Department of Surgery,
Department of Pathology, National Cancer Institute, Cairo University, Egypt
Correspondence to:
Hatem Aboul Kassem, Email: [email protected]
Aim: Unfortunately, lumpectomy is still the most diagnostic tool for breast
carcinoma in Egypt. Management of Tx breast carcinoma is still a controversial issue. Most of these patients are doomed to undergo mastectomy.
The aim of this study is to analyze patients with Tx breast carcinoma after
having their definitive treatment as regard residual disease in the lumpectomy cavity and factors affecting it.
Methods: 60 patients with Tx breast carcinoma who had lumpectomy for
a localized breast lump and were proved to be invasive breast cancer were
subjected to this study. They were operated from January 2003 to December 2010. Pathologic and patient characteristics were all reviewed.
Results: In this sample, the median age of the patients was 45 year, and
the median tumor size was 3 cm. 52 patients (86.7%) had mastectomy and
8 patients (13.3%) had conservative breast therapy (CBT). Residual disease
was present in 22 patients (36.7%). Margins less than 5 mm had residual
tumors in 90.9% of cases. Tumors larger than 2.5 cm in diameter showed
residual disease in 52.9% of cases. The other independent factors as age,
sex, laterality and grade of tumor had no statistically significant effect on
residual tumor.
Conclusion: Mastectomy is not the only option for management of Tx
breast cancer. Breast conserving therapy is still a valid option provided
that a wide safety margin is excised with definitive negative margins.
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Extending the indications of breast conserving surgery;
the oncoplastic approach
Omar Z. Youssef M.D, Professor of surgical oncology
National Cancer Institute- Cairo University, Egypt
Abstract:
Background:
Surgical management of patients with breast cancer includes either
breast-conserving surgery (BCS) or mastectomy with or without reconstruction. Both options have similar rates of long-term survival, but BCS
is associated with superior cosmetic and psychological outcomes. A more
recent pathway is oncoplastic surgery (OPS) that allows for wider tumor
resection with immediate reconstruction of the defect, avoiding mastectomy for a subset of patients, hence extending the indications of BCS for
these patients.
Patients and methods:
This study includes 145 patients with breast cancer, who underwent oncoplastic resection of their tumors. Fifty patients underwent wide local excision and glandular reshaping (WLE+GR), 44 patients underwent therapeutic mammoplasty (TM) and 51 volume replacement procedures (VR)
Results:
Mean size of tumor in the first 2 groups was 3.1cm (Range 1.8 to 4.7 cm);
while in the third group was 3.6cm (Range 2.8 to 8.6cm). The minimal margin width in the first 2 groups was 1.6cm (Range 0.8 to 4.8 m) and in the
third group was 2.4 cm (Range 1.4 to 18 cm) Only one patient in VR group,
had positive margins and underwent completion mastectomy. None of
the patients had delay in their adjuvant treatment. Only one case had
local recurrence in the first group after 19 months
Conclusion:
Although our study has a relatively short follow-up period, however, it
confirmed the results of other studies that concluded that OPS is an oncological safe procedure and is a good third option for breast cancer surgery
with good oncological and better cosmetic outcome.
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Groin recurrence in patients with vulvar cancer with
pathologically negative nodes on superficial inguinal
node dissection
H.A. Aboulkassem, A.H. Elaffandi and M.I. Elsherbiny
National Cancer Institute, Cairo University, Egypt.
Abstract:
Objectives
The objective of the study is to investigate the causes of the groin recurrence in patients with carcinoma of the vulva who had negative nodes in
their superficial inguinal node dissection (SIND) specimens.
Material and methods
A prospective nonrandomized trial has been conducted in the period
between 2005 and 2009 on 41 patients having squamous cell carcinoma
of the vulva. The depth of invasion was more than 1 mm in all cases. Stage
I included 13 patients and stage II included 26 patients. The number of
patients who had unilateral sited lesions was 24 (4 had lesions within 1cm
from the midline). The number of patients who had bilateral sited lesions
was 17.They were then subjected to the standard treatment in the form
of radical local excision with a safety margin 2 cm confirmed using intraoperative frozen section and SIND either in the form of unilateral inguinal dissection (20 patients) or bilateral inguinal dissection (21 patients).
Among these patients 7 experienced groin recurrence that involved both
side (1 patients) and one side (6 patient). Patients who suffered groin
recurrence have been thoroughly investigated using CT pelvis and groin to
exclude the presence of iliac nodes and to detect roughly the state of the
vessels which was further evaluated using colored Doppler ultrasound.
The recurrent cases have been subjected to deep inguinal nodal dissection (1 patient required ilioinguinal nodal dissection). No femoral vessel
resection has been needed however femoral nerve resection has been
done in 1 patient. Sartorius transposition has been done to protect the
vessels after complete resection. Two patients required reconstruction of
the skin defect using myocutanious flaps. In addition to the histopathological study of the resected nodes more slides were reviewed (5 sections
from paraffin block of the previously resected superficial inguinal nodes)
to exclude micrometastasis.
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Results
The median age at diagnosis and primary surgery was 59 years and the
median depth of invasion was 4mm (more than 5 mm in recurrent cases).
The size of the primary tumor ranged from 1.8 cm to 4.3 cm in the non
recurrent cases while the range was 3 cm to 4.5 cm in recurrent cases. Six
patients underwent unilateral groin dissection and one patient underwent
bilateral groin dissection. The mean number of the lymph nodes removed
per groin was 8 with an average size ranging from 0.4cm to 3.5cm. The
median time to recurrence was 21 months. On examining the resected
recurrent tissue, it has been found that in 1 patient recurrence has been
identified in fibro adipose tissue. In the remaining 6 patients nodal tissue
has been detected in the resected specimens. No micrometastasis has
been detected in the reviewed slides.
Conclusion
We suggest that the groin relapse in patients with negative nodes on SIND
is caused by metastatic disease in unresected inguinal nodes. All of the
recurrent cases had stage II disease (size of the primary tumor > 3 cm
while the depth was > 5 mm). SIND does not eliminate all the sites of the
possible nodal metastasis in patients with the above mentioned measurements (stage II)
Accelerated Balloon-Occluded Retrograde Transvenous
Obliteration Of Gastric Varices Without Retaining The
Occlusion Balloon Using A Terminal Gel Foam Plug in HCC
Patients.
Wael Darwish
Abstract:
Balloon-occluded retrograde transvenous obliteration in four consecutive
cirrhotic HCV positive, Hepatocellular cancer (HCC) patients with gastric
varices without indwelling balloon catheter occlusion, aiming to prevent
gastric variceal bleeding.
The four patients presented with HCC for treatment and the gastric varices was discovered on their initial or follow-up MRI or CT scans.
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Methods:
Alcohol was mixed with iodized oil and room air as much as possible to
form a concoction that was injected in a retrograde fashion through the
relatively small gastrorenal shunts, followed by a thick absorbable gelatin
sponge plug under only 10-minute balloon occlusion (without keeping an
indwelling balloon).
CT & or endoscopy were performed within a month to monitor the gastric
variceal occlusion/thrombosis and follow-up the esophageal varices.
MELD score, Child-Pugh scores and the rest of renal and liver function labs
were obtained as well as a complete blood picture were performed before
and after the procedure periodically.
Results: All four balloon-occluded retrograde transvenous obliterations
were technically successful. No instilled sclerosant migration occurred
after deflating and removing the balloon occlusion catheter. No procedural complications occurred. There was prompt prevention of the anticipated gastric variceal bleeding,
at a mean clinical follow-up of nine months with complete thrombosis of
the the gastric varices.
Conclusion: Because complete obliteration of gastric varices was achieved
in all patients without any complications, our technique is considered to
be safe and effective for small gastric varices in cirrhotic HCC patients.
First Author: Wael M. Darwish, MD, MSc.
A. Lecturer of Radiology, Medical Director of VIR,
National Cancer Institute, Cairo University.
[email protected]
+201000709702
Co-author: Ikram H. Mahmoud, MD, PhD
Professor & Chairman of Radiology and Image guided Interventions, National
Cancer institute, Cairo University.
[email protected]
+201001456261
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Early Results of NCI, Cairo University in chemo-embolization of HCC in cirrhotic, HCV positive patients using Hepaspheres 30-60 & 50-100 microns with a restrict inclusion
criteria and a unified maximum treatment dose.
Wael Darwish
Abstract:
This study was started May, 2013 to examine the efficacy of trans-arterial
chemo-embilization of hepatocellular carcinoma (HCC) in hepatitis C virus
(HCV) positive cirrhotic patients using a superabsorbent polymer drug
eluting embolic material.
Methods & Early results :
One hundred and seventy six patients with documented HCV positive
results, cirrhosis and HCC, Child-Pugh score A, ECOG performance status
0-2 and having one to three lesions not amenable to ablation or resection.
Hepaspheres 50-100 microns were used in one hundred and forty eight
patients with a maximum dose of 50 mg Doxorubicin prepared on 50
mg hepaspheres per session. Hepaspheres 30- 60 microns were used in
twenty eight patients with a maximum dose of 50 mg Doxorubicin prepared on 50 mg hepaspheres per session.
All the lesions were embolized using various 5 F. catheters to select the
Celiac axis, Superior mesenteric, right renal, inferior phrenic, intercostal, right internal mammary and left gastric arteries, then superselection of the feeding arteries as possible was done using Renegade Hi-flow
microcatheter over 0.018 inch or 0.014 inch transcend microwire before
the start of embolization. Arterio-venous shunting within or around the
lesions were dealt with according to the presentation if found.
All the needed labs were repeated after each embolization session by 21
days and a follow-up Dynamic MRI/DTI-ADC map was performed in the
fourth week post-embolization.
A period of 3-4 weeks was left between embolization sessions if more
than 1 embolization session was needed.
If a complete response was reached the MRI is then performed after 3
months from the last MRI examination, and if there is no new lesions or
recurrence it’s then performed every 6 months.
Response rates were calculated on intention to treat basis with complete
response (CR) 22.4% reaching 27.8% for the targeted lesions. Over all
25
partial response (PR) was seen in 53.3%, stable disease in 15.1%, and progressive disease 9.1% of patients. Overall objective response (CR+PR) was
seen in 75.7% of cases.
Until August 2014 Mortality rates were 0% at 1 & 6 months and 2.1 % at 1
year (1 patient from the 47 patients who passed a year from the start of
treatment) due to progressive liver cell failure/hematemesis.
Conclusion:
Drug eluting chemoembolization using hepaspheres is an effective modality of treatment for HCC in HCV positive patients that needs to be more
evaluated on larger samples of patients and on longer periods of followup that will be continued in our study.
First Author: Wael M. Darwish, MD, MSc.
A. Lecturer of Radiology, Medical Director of VIR,
National Cancer Institute, Cairo University.
[email protected]
+201000709702
Co-author: Ikram H. Mahmoud, MD, PhD
Professor & Chairman of Radiology and Image guided Interventions,
National Cancer institute, Cairo University.
[email protected]
+201001456261
Patterns of failure and Predictors of recurrence for urothelial bladder cancer after Radical Cystectomy: an Egyptian study performed at the National Cancer Institute,
Cario University
Hatem Aboul Kassem
Abstract
Background: Radical cystectomy remains the gold standard for local control of muscle invasive bladder cancer for decades. Despite this radical
surgery, a significant proportion of patients develop disease recurrence.
A detailed review of literature revealed a significant number of studies
dealing with the patterns of failure/recurrence, and the predictive factors
26
associated with recurrence. The implications of such predictive factors on
development of recurrence will help in modification of treatment strategies, in an aim to improve the prognosis of bladder cancer.
Methods: This is a retrospective case-control study on patients with transitional cell carcinoma who underwent radical cystectomy at the National
Cancer Institute in the three-year period between January 2007 to December 2009, and analyzed for the development of recurrence and potential
risk factors.
Results: Our study included 166 males (87.8%) and 23 females (12.16%).
Their median age was 62 years (range: 31-85). One and five-year disease
free survival rates were 77.2% and 53.6% respectively. Seventy one patients
(37.56%) developed disease recurrence during the follow-up period. Of
these recurrences; 17 patients (23.9%) were local and/or regional, while
45 (63.38%) developed distant metastasis, and eight (11.26%) developed
both local/regional and distant recurrences. Site of recurrence was not
documented in one patient. The most common site for distant metastasis
was the skeletal system. On univariate analysis; lymph node metastasis
(p<0.001), lymphovascular invasion (p<0.001), high grade (p=0.012) and
extravesical extension (p=0.033) were positively associated with development of recurrence. On multivariate analysis, lymph node metastasis,
lymphovascular invasion and high grade are associated with tumor recurrence and poor disease-free survival.
Conclusions: Lymph node metastasis, lymphovascular invasion and high
grade are independent factors affecting tumor recurrence and diseasefree survival. Other factors should be taken into account when assessing
patient prognosis after radical cystectomy to improve accuracy and aid
decision making.
Keywords:
Urothelial carcinoma - Radical cystectomy - Predictors of recurrence
27
Pelvic Exentration and Composite Sacral Resection In the
Surgical Treatment of locally Recurrent Rectal Cancer.
Wael Gawad, Medhat Khafagy, Mohamed Gameil, Moustafa Negm,
Nadia Mokhtar, Mohamed Loutaef, Osman Mansour
National Cancer Institute - Cairo University, Cairo, Egypt.
Abstract
Background
The incidence of rectal cancer recurrence after surgery is 5-45%. Extended
Pelvic resection such as pelvic exentration and abdominosacral composite resection which entails Enbloc resection of the tumour and adjacent
involved organs provide the only true possible curative option for patients
with locally recurrent rectal cancer. The Aim of this study is to evaluate the
surgical and oncological outcome of such treatment.
Methods: Between 2006 and 2012 a consecutive series of 40 patients with
locally recurrent rectal cancer underwent abdominosacral resection (ASR)
in 18 patients, total pelvic exentration with sacral resection in 10 patients
and pelvic exentration in 12 patients. Patients with sacral resection were
28, the level of sacral division was at S 2/3 interface in 10 patients, S 3/4 in
15 patients and S 4/5 in 3 patients.
Results:
Forty patients, male to female ratio 1.7:1, mean age 45 years (range 25
– 65 Y) underwent extended pelvic resection in the form of pelvic exentration and Abdominosacral resection. Average blood transfusion was
(0.4-6L), median hospital stay was 21 (range 7-52) days. The Morbidity,
Readmission and Mortality rates were 55%, 15% and 5% respectively. The
reported surgical complications were as such, wound gap in 10 patients,
neurogenic bladder in 9 patients and enteric fistula in 9 patients. Mortality occurred in 2 patients due to enteric fistula and abdominal sepsis.
A R0 and R1 sacral resection were achieved in 63% and 37% respectively.
Thirty five patients underwent curative resection, they showed significantly improved survival with 5-year survival rate of 26.3% compared to
5 patients with palliative resection in a survival rate of 0%.Conclusion:
Extended pelvic resection as pelvic exentration and sacral resection for
locally recurrent rectal cancer are effective procedures with tolerable
mortality rate and acceptable outcome. The associated morbidity remains
high and deserves vigilant follow up.
28
Profile of Cancer Pathology in Egypt
and the Role of Markers in Patients’ Management
Nadia M. Mokhtar, MD, PhD
Professor of Pathology
National Cancer Institute, Cairo University
Figure 1: A 12-year Cancer Pathology Registry, Mokhtar et al 2014, NCI, Cairo University
Cancer Pathology Registry at the Department of Pathology of the National
Cancer Institute (NCI), Cairo University is a periodical documentation data,
regularly published by NCI. The recent issue of 2014 draws the relative frequency data of tumors and forms a detailed profile for a hospital-based
registry allowing for a dynamic profile with time trend analysis. The material is presented with recent pathologic classifications, grading, and staging, including immunohistochemical and molecular test applications.
Biopsy, specimens, frozen sections, FNAC procedures are applied when
appropriate. The most frequent 4 systems presented in this registry are
the breast, GIT, Urinary system, and lymphoid neoplasms (figure 1).
Breast cancer forms a majority of 36% of female cancers with a T2 stage
predominance and high lymph node involvement in more than 70% of
cases. All cases are routinely tested for hormone receptors (ER and PR),
Her-2/neu, and Ki-67 by automated immunohistochemistry. In situ hybridization (CISH) is applied in selected cases. Oncotype DX is applied to a few
early breast cancer cases. Material is sent abroad for this test.
Urinary system is the second most common due to high incidence of
29
schistosoma-associated bladder carcinoma (endemic bilharziasis). A close
association was noted between the parasitic infestation of schistosoma
hematobuim and the causation of bladder cancer with special clinicopathologic features, confined to the endemic area. However, lately during the last 2-3 decades a change was noticed and documented in subsequent Pathology Registries. A significant decline of the relative frequency
of bladder cancer was decreased from 27% in old series to 12% in recent
ones. Bilharzial association dropped from 82% to 55%. This is attributed
to better control of bilharziasis by the Egyptian Ministry of Health in the
rural population in Egypt. The change is also reflected on the histopathologic types. There was a significant decrease in squamous carcinoma, previously predominated and rise of transitional cell carcinomas from 16.0%
to 60%, becoming at present the most common tumor type in bladder
cancer. Such a pattern is approaching that of the Western World.
The digestive and hepatobiliary systems form 20% of total malignancies.
Colorectal cancer is the most common with predominance of T3 and high
grade tumors. Routine molecular ras testing is done for metastatic cases
prior to targeted therapy. Also GIST tumors are common in GIT with routine c-kit immunostaining for established diagnosis and prior to targeted
therapy. Molecular testing for exon 9 is applied on resistant metastatic
cases. Hepatocellular carcinoma shows a high rise in incidence in recent
registries due to high HCV infestation and endemic pattern. Most tumors
arise on top of liver cirrhosis and active interface hepatitis.
Malignant lymphomas are the 4th most common tumors in the registry.
Cases show a predominance of non-Hodgkin lymphoma forming 72%,
while Hodgkin lymphoma forms 28%. There is a predominance of B-cell
NHL of 84% and diffuse large B-cell lymphoma is the most frequent subtype of lymphoma, forming half of the cases. Small lymphocytic lymphoma forms only 6% and follicular lymphomas a low of 4%. Automated
immunohistochemical stains are used routinely for accurate phenotyping
and subtyping. Markers used are mainly CD20, CD3, CD43, LCA, CK, CD30,
CD15, CD10, CD23, CD5, CD10, CD21, bcl-2, cyclinD1, kappa, lambda. Ki-67,
MUM1, and bcl-6. Gene rearrangement tests are applied in difficult cases.
Other less frequent systems are shown in Figure 1. Immunohistochemistry and molecular markers like EGFR, kras, and ALK are applied in some
cases of lung cancer prior to targeted therapy.
30
Pre-operative Placement A Supra-renal (infra-atrial) IVC
Filter in Cases of Renal/Adrenal Tumors with Tumoral
Venous Thrombi Extending into the IVC to Prevent Accidental Intra-operative Pulmonary Embolism.
Wael Darwish
Abstract:
A total of four patients, 3 males with Renal cell cancer (RCC) and 1 female
angiomyolipoma received a supra-renal infra-atrial (Inferior Vena Cava)
IVC filters, and two of them underwent pre-operative bland renal arterial
embolization to prevent intra-operative tumoral pulmonary embolism ,
and reduce intra-operative blood loss respectively.
Methods:
A triphasic CT scan was performed prior the procedure, with a CT venography, the distance from the top of the thrombus to the right atrium (patent infra-atrial IVC was measured ) with a mean of 4.5 cm.
A right Internal Jugular access was used to perform an IVC venogram
through an eleven French sheath and a Universal Cook Celect Filter was
placed through the same access.
Radical nephrectomy and thrombectomy was performed within two days.
Three weeks CT follow-up was performed.
Results:
Technical success was 100% (to place the filter). The three weeks followup showed no pulmonary or IVC residual thrombi, filter fracture, wall penetration or migration, however a filter tilt was noted in one case with hook
projecting into the hepatic veins confluence.
Conclusion:
Placing a pre-operative infra-atrial (supra-renal) IVC filter is a technically
safe procedure that should be adopted by Interventional radiologists to
reduce radical nephrectomy/tumoral IVC thrombectomies.
First Author: Wael M. Darwish, MD, MSc.
A. Lecturer of Radiology, Medical Director of VIR,
National Cancer Institute, Cairo University.
[email protected]; +201000709702
31
Co-author: Ikram H. Mahmoud, MD, PhD
Professor & Chairman of Radiology and Image guided Interventions,
National Cancer institute, Cairo University.
[email protected]; +201001456261
Targeted chemo infusion for local control of invasive
breast cancer utilizing a retrograde subclavian artery
resivoir post-redistribution of the breast bed arterial
supply.
Wael Darwish
Lecturer of Interventional Radiology
National Cancer Institute, Cairo University
Abstract:
Purpose: To describe the technique and evaluate effectiveness of a retrograde reservoir directed subclavian artery chemoinfusion with redistribution of the mammary vascular bed by obliterating the internal mammary
artery (IMA).
Materials and methods: A prospective study was performed in May 2008.
Patients with locally advanced primary tumor (stage > = IIIb). Prior radiation therapy was the only exclusion. The ipsilateral brachial artery was
accessed and the axillary artery was cannulated in a retrograde fashion.
The IMA was embolized utilizing N-butyl cyanoacrylate and lipiodol to
redistribute the arterial supply to the breast to make it solely from the
subclavian branches. A 5-French (tapered to 3.3-French) catheter was
placed with its tip distal to the takeoff of the IMA and vertebral artery and
connected to a port-a-catheter reservoir placed in a forearm subcutaneous pocket. Chemotherapeutic agents were administered weekly via the
reservoir starting intraoperatively. Administered agents included 30 milligrams Adriamycin (intraoperatively), 750 milligrams of 5-Flurouracil and
10 milligrams of Cisplatimum. This was repeated for 3-6 months. Tumor
response was by CT tumor volumetry and graded by Response Evaluation
Criteria in Solid Tumors [RECIST: complete response (CR), partial response
(PR), and Stable disease (SD) represented 100%, >50%, and <50% tumor
reduction respectively].
32
Results: 5 patients were enrolled. 1 patient had hand gangrene at 2 weeks,
and a foot gangrene at 8 weeks. The remaining 4 patients had a RECIST PR
(50% tumor reduction) achieved at 1.1 - 4.3 months (mean 2.3 months).
Conclusion: Locoregional subclavian artery weekly chemo infusion with
arterial bed redistribution by occluding the IMA is effective.
Targeted irinotecan eluting hepaspheres arterial embolization of hepatic metastatic colorectal cancer.
Wael Darwish
Lecturer of Interventional Radiology
National Cancer Institute, Cairo University
Abstract:
Purpose: To evaluate effectiveness of arterial embolization of hepatic
colorectal metastatic liver disease using Irinotecan eluting hephaspheres.
Materials and methods: A prospective study is being performed from
February 2012 in NCI, Cairo University, Egypt. Patients who underwent
surgical resection of the primary colorectal cancer, having or later developed liver metastatic disease. The patients could have started systemic
chemotherapy or with concomitant chemotherapy at the time of arterial
embolization. CT &/or MRI was performed on the liver as well as the operative bed to define the extent of the metastatic liver disease and evaluate
the operative bed. A right common femoral artery access was done, followed by imaging of the superior mesenteric artery, Celiac axis, hepatic
artery, left gastric and phrenic, right renal arteries if was indicated by a
5 French catheter. further selection of the hepatic artery branches was
performed using a 2.8 French microcatheter that was used for injecting the prepared Irinotecan (100 mg/2 ml) eluting (50 mg) 30-60 microns
hepaspheres. Stopping the injection was considered after stopping of the
arteriolar flow on angiography. This was repeated four weeks if there is
residual on the Dynamic liver MRI (Magnetic Resonance Imaging) +/- DTI
(Diffusion Tensor Imaging) in the early fourth week. Tumor response was
by MRI tumor volumetry, Diffusion facilitation, and decrease or disappearance of lesion contrast enhancement.
33
Results: twelve patients were enrolled till now. 6 patients had disappearance of vascular enhancement, and diffusion facilitation with later reduction in the tumor volume after an average of 2.1 sessions and are under
follow up after 3 months, then every 6 months by Dynamic MRI/DTI. Two
patients had partial response of more than 30% reduction of all the above
mentioned criteria. Two patients had stable disease. Two patients had
progressive disease with stopping of treatment due to high bilirubin due
to peripheral bile ducts obstruction even after bilobar biliary drainage.
The other one after refusing further treatment after 13 months of followup following the first two sessions.
Conclusion: Catheter directed (targeted) Irinotecan hepasphere arterial
embolization of colorectal liver metastases is of value, yet larger volumes
of patients are needed for further evaluation of the modality.
The Incidence and Distribution Of Cancer In the Arab
world and Egypt.
Wael Gawad
The Arab world includes 22 countries with a total population of nearly
362 million.
The Urban / Rural population split is about 55.8/45.2 %. The Arab world
has the following common epidemiological features which contribute to
the profile of cancer problem;
(1) High incidence of infections and Malnutrition.
(2) Young population age.
(3) Increasing industrialization and urbanization accompanied by lack of
protective measures.
(4) High Solar exposure.
(5) Inadequate public awareness leading to late case presentation.
Cancer Registration is a vital tool for sizing the cancer problem, hence
determing the strategic planning for treatment, control and prevention.
34
The Cancer profile among Arab countries is characterized by a high frequency of Breast, Prostate, Bladder, Colo-Rectal, Lung , Liver, Oesophagus
and Cervix . Relatively high frequency rates of lung Cancers were reported
from Baharain, Tunisia, Libya, Moraco and Algeria.
In Egypt ,the mean age of Cancer Patients is 48 years, nearly two decades
younger than western patients. According to the National Cancer Registry, there is a slight male predominance in cancer ratio 1.05 : 1.
The leading cancers among Egyptian Patients according to the National
cancer Registry are: Breast, Urinary Bladder, NHL, Liver, Lung, Leukaemia,
Colorectal, Brain, CNS, prostate & ovary.
Unser Dank geht an die Sponsoren der Veranstaltung:
Roche Deutschland Holding GmbH 6.000 €, Europäische Branchenkompetenzzentrum für
die Gesundheitswirtschaft 4.000€, Novartis Oncology 4.000 €, W.O.M. WORLD OF
MEDICINE GmbH 2.000 €
35
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